Critical Care Exam 1 (part one)

Assess the client's lung sounds.

An older adult client diagnosed with end stage-renal disease (ESRD) presents with fluid volume excess. What is the priority nursing intervention?

1. Water & sodium retention 2. Secondary to a severe decrease in GFR

Chronic renal failure increases the patient's risk of ___________________________ secondary to a severe decrease in _________________.

4.5-8

What is normal urine pH?

Men: 107-139 mL/min Women: 87-107 mL/min

What is the normal range for 24 hour Creatinine Clearance tests?

1. NSAIDS 2. Antibiotics (gentamycin) 3. Digoxin 4. Cocaine, Heroin, Meth 5. Chronic UTI meds 6. Lasix 7. Hydrocarbon exposure 8. Contrast media

What types of medications could affect renal function?

1. Uremia (build up of wastes in the blood) 2. Anemia (not enough erythropoietin) 3. Acidosis (can't excrete hydrogen ions)

Which clinical findings should a nurse look for in a client with chronic renal failure?

Dopamine

Which drug is most commonly used to treat cardiogenic shock?

Prothrombin Time (PT)

Which test determines a client's response to oral anticoagulant drugs?

Oliguria

What is the most common initial symptom of Acute Renal Failure?

Sudden decrease in urine output.

What is the most significant sign of acute renal failure?

6-25

What is the normal BUN/Creatinine ratio?

10-20 mg/dL

What is the normal range for BUN?

0.6-1.2 mg/dL

What is the normal range for Creatinine?

Men: 40-50 % Women: 37-45%

What is the normal range for Hematocrit?

Intra-aortic Balloon Pump

What mechanical device increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock?

Risk for infection

What nursing diagnosis is most appropriate for a client with renal failure undergoing continuous ambulatory peritoneal dialysis?

1. Chest pressure 2. Chest tightness 3. Jaw pain 4. Tachypnea 5. Tachycardia

What signs & symptoms would a nurse expect to see in a client with angina?

Palpate to check for a distended bladder.

A client is voiding small amounts of urine every 30 to 60 minutes. What should the nurse do first?

Fluid overload

Decreased Hematocrit could indicate _________________.

30 mL/hr

Urine output of _________ mL/hr or more is considered acceptable.

Intra-Aortic Balloon Pump

A _________________________ increases coronary perfusion and cardiac output, and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock.

Anticoagulant

A client has a blockage in the proximal portion of a coronary artery. After learning about treatment options, the client decides to undergo percutaneous transluminal coronary angioplasty (PTCA). During this procedure, the nurse expects to administer what med?

Take a manual BP. (if the line is accurate place the patient in Trendelenburg, if not accurate, flush & recalibrate)

A client in the intensive care unit has an arterial line which reads 58/30 mm Hg on the monitor. What is the nurse's first action?

1. Give Morphine 2. Give Oxygen 3. Give Nitroglycerin 4. Give Aspirin

A client is admitted to the emergency department with sudden onset of chest pain. Which prescriptions should the nurse implement immediately?

Troponin 1 levels because they rise with MI.

A client is admitted to the hospital through the emergency department with chest pain. What lab value assessment is the priority?

Start IV fluids with a NS bolus followed by a maintenance dose because the patient is in prerenal failure caused by hypovolemia.

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for what type of treatment?

The number of premature ventricular contractions is decreasing.

A client is given Amiodarone in the emergency department for a dysrhythmia. What finding indicates the drug is having the desired effect?

Low blood pressure triggers the baroreceptors to increase sympathetic nervous system stimulation.

A client is in the early stage of heart failure. During this time, which compensatory mechanism occurs?

Monitor respiratory status (because pressure of the solution on the diaphragm could cause respiratory distress)

A client is receiving peritoneal dialysis. What should the nurse assess while the dialysis solution is dwelling in the client's abdomen?

Avoid eating foods high in potassium

A client is taking spironolactone. Which change in the diet should the nurse teach the client to make when taking this drug?

Assess the BP.

A client presents with a heart rate of 30 beats/min. The nurse notes a pacemaker in the client's right upper chest wall. Which is the nurse's priority action?

1. Reduces myocardial oxygen consumption 2. Reduces BP & HR 3. Reduces anxiety & fear

A client with acute chest pain is receiving I.V. morphine sulfate. What are some expected effects of morphine?

Recent streptococcal infection (findings indicate acute glomerulonephritis)

A client with acute onset renal dysfunction comes to the ER complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history, the nurse should also ask about _________________.

Cardiac Rhythm (because of potassium level)

A client with chronic kidney disease (CKD) has a blood urea nitrogen (BUN), 100 mg/dL, serum creatinine 6.5 mg/dL, potassium 6.1 mEq/L, and lethargy. What is the priority nursing assessment?

Epoetin Alfa

A client with chronic renal failure who receives hemodialysis three times weekly has a hemoglobin (Hb) level of 7 g/dl (70mmol/L). The most therapeutic pharmacologic intervention would be to administer what medication?

Ensuring that the metformin has been withheld for 48 hours prior to the scan because it could cause kidney damage when mixed with the CT contrast.

A client with type 2 diabetes mellitus who is taking metformin is scheduled for a computed tomography (CT) with contrast of the abdomen tomorrow. Which of the following is a priority nursing assessment done before the procedure?

Massive proteinuria

A nurse is assessing a client with nephrotic syndrome. The nurse should assess the client for which condition?

Hyperkalemia

A nurse is caring for a client in acute renal failure. The nurse should expect hypertonic glucose, insulin infusions, & sodium bicarbonate to be used to treat ________________.

Give atropine 0.5 mg IVP as ordered.

A nurse is caring for a client who is experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg & he complains of dizziness. What is the nurse's priority action?

Carvedilol (Beta blockers may mask hypoglycemia so it should be closely monitored.)

A nurse is caring for a client with a history of cardiac disease and type 2 diabetes. The nurse is closely monitoring the client's blood glucose level. Which medication is the client most likely taking?

Greater than 7 mEq/L

A potassium level greater than _________ mEq/L may produce fatal cardiac dysrhythmias.

<3.5 (hypokalemia)

A potassium level of ___________ may predispose a patient to Digoxin toxicity.

1. Absence of edema 2. BP increase

After giving Albumin to a patient with Nephrotic Syndrome, what are some expected outcomes?

Weight loss

After hemodialysis, a patient with chronic renal failure is most likely to experience _____________.

Binding phosphate in the intestines.

Aluminum hydroxide gel (Renagel) is prescribed for the client with Chronic Renal Failure to take at home. What is the expected outcome of this drug?

Increases

As urinary output decreases, potassium _________________.

1. Vitals (BP) 2. I&Os

Because hypotension is a complication associated with peritoneal dialysis, the nurse records ________________, ________________, & observes the client's behavior.

Digoxin

Cardiac glycosides such as _______________ should be held during dialysis.

Dialysis Equilibrium Syndrome

Condition that results from an excess of interstitial or intracellular solutes caused by rapid solute removal from the blood during dialysis. It can result in organ swelling which interferes with normal functions. Common in first time dialysis sessions.

Cardiogenic Shock

Condition where the heart has been significantly damaged & is unable to supply enough blood to the organs of the body.

Slow the rate of dialysis.

During dialysis, the client has disequilibrium syndrome. What should the nurse do first?

Turn the client side to side.

During dialysis, the nurse observes that the flow of dialysate stops before all the solution has drained out. What should the nurse do?

Indicates abdominal blood vessel damage.

During peritoneal dialysis, the nurse sees solution draining from the client's abdomen is consistently blood tinged. The client has a permanent peritoneal catheter in place. What judgment should the nurse make about the blood-tinged drainage?

1. Contrast media 2. Antibiotics 3. Corticosteroids 4. Bacterial toxins

Intrinsic/Intrarenal failure results from damage to the kidney, such as from nephrotoxic injury caused by _________________, ________________, ________________, or _________________.

1. Cloudy diastylate fluid drainage 2. Fever 3. Hyperactive bowel sounds 4. Abdominal pain

For a patient receiving continuous ambulatory peritoneal dialysis, what are some signs of peritoneal infection?

Tall peaked T-waves

Hyperkalemia, a life threatening complication of Acute Renal Failure, is characterized by ___________________________ on an ECG.

Renal insufficiency/failure

If a client has had HTN for 20 years, the nurse should assess the client for ___________________.

Adhesive bandages

Immediately after a dialysis treatment, the access site should be covered with __________________________, not gauze.

Creatinine Clearance

In a client with decreased renal function, antibiotic dosage should be adjusted based on the patient's _______________________.

Hemorrhage, sepsis, & anaphylaxis.

In presenting a workshop on parameters of cardiac function, which conditions should a nurse list as those most likely to lead to a decrease in preload?

Fluid deficit

Increased Hematocrit could indicate ___________________.

Increase CO

What is the major clinical use of Dobutamine?

1. Elevated ST segment, 2. Inverted T-wave 3. Pathological/significant Q-wave

Ischemic myocardial tissue changes cause elevation of the __________, an inverted ____________, & a pathological/significant _______________.

2-3 lbs/day

Patients with renal impairment should report weight gain of __________ or more lbs a day.

Increase CO

What is the major goal of nursing care for a client with heart failure and pulmonary edema?

No, because they both increase the risk for hyperkalemia.

Should ACE inhibitors be administered with potassium-sparing diuretics such as spironolactone or amiloride?

Hyperkalemia

The client has been prescribed lisinopril to treat hypertension. The nurse should assess the client for which electrolyte imbalance?

Reduced renal blood flow

The client who is in Acute Renal Failure has an elevated BUN. What is the likely cause of this finding?

8 glasses

The client who is taking sulfadiazine should be instructed to drink at least _____________ of water a day to prevent the development of crystalluria

Gelatin

The client with acute renal failure asks the nurse for a snack. Because the client's potassium level is elevated, what snack is most appropriate?

Assess orientation & vital signs to determine if the rhythm is life-threatening.

The monitor technician informs the nurse that the client has started having premature ventricular contractions every other beat. What should the nurse do first?

Immediate defibrillation

The nurse caring for a client on the cardiac unit notices that the client's cardiac monitor shows ventricular fibrillation. What is the priority action by the nurse?

1. Short period of asystole 2. Bradycardia 3. Hypotension 4. Dyspnea 5. Chest pain followed by a return to normal sinus rhythm.

The nurse is administering adenosine to a client with supraventricular tachycardia. What is the expected therapeutic response?

1. Lethargy 2. Drowsiness 3. N/V

The nurse is caring for a client with Chronic Renal Failure. The nurse should monitor the client for which adverse effects of hypermagnesemia?

Bruit & Thrill

The nurse needs to assess the AV fistula for a _____________ & _______________ because if these findings aren't present, the fistula isn't functioning.

PTT 1.5 to 2.5 times the normal control.

The nurse should adjust a client's heparin dose according to a prescribed anticoagulation order based on maintaining which laboratory value at what therapeutic level for anticoagulant therapy?

When HR falls below a specified level.

The nurse teaches the client with a demand pacemaker that the device functions by providing stimuli to the heart muscle when __________________________.

Aspirin

The use of ___________ is contraindicated while taking warfarin because it will potentiate the drug's effects.

2 grams or less.

To lower blood pressure, patients should limit their daily salt intake to _______________.

Anuria

Urine output that's less than 50 ml in 24 hours is known as ______________.

1. PVC 2. V-tach (with a pulse) 3. A-fib 4. Atrial Flutter

What 4 conditions is Amiodarone used to treat?

Assess the lungs for crackles.

What action should the nurse take after finding a third heart sound (S3)?

1. Skin rashes, bruises or yellowing, bad turgor, dry 2. Bruit, fluid overload in lungs 3. S3 & other abnormal heart sounds 4. Masses 5. Sacral, pedal, or pretibial edema 6. CVA tenderness 7. Ascites 8. Metallic taste 9. Uremia

What are some assessment findings that may be seen in someone with renal impairment?

1. Ventricular arrythmias/irregular pulse 2. Hypokalemia (<3.5) 3. Ototoxicity 4. Hyperglycemia 5. Muscle cramps/Decreased tone 6. Dizziness/Weakness 7. Urticaria/Pruritis 8. Photosensitivity

What are some examples of adverse effects to Loop diuretics?

1. Decreased LOC 2. Confusion 3. Seizures 4. Headache

What are some symptoms of Dialysis Disequilibrium Syndrome?

1. Decreased O2 sat 2. Dyspnea & Tachypnea 3.Oliguria 4. Crackles or wheezes 5. Tachycardia/palpitations 6. Weak peripheral pulses/cool extremities/pallor 7. S3 or S4 8. Dizziness, confusion, restlessness, fatigue 9. Angina

What are some symptoms of left-sided HF?

1. Periorbital Edema 2. Hematuria 3. Proteinuria 4. Fever, chills 5. Weakness 6. N/V 7. Pallor 8. Anorexia

What are some symptoms of sudden onset Acute Glomerulonephritis?

1. Keep first time sessions short. 2. Use a reduced blood flow rate.

What are some ways to prevent Dialysis Disequilibrium Syndrome?

1. Massive proteinuria 2. Peripheral edema 3. Hyperlipidemia 4. Hypoalbuminemia 5. Weight gain

What are symptoms of nephrotic syndrome?

They block sodium reabsorption in the ascending loop & dilate renal vessels.

What best describes the therapeutic action of loop diuretics?

Ventricular dilation

What complication does S3 indicate?

1. Low protein, Na, & potassium 2. High carbohydrate 3. Vitamin & mineral supplements

What diet is appropriate for a patient with Chronic Renal Failure?

Myocardial Infarction

What do elevated ST segments on an ECG indicate?

2-2.5 times normal.

What is considered a normal aPTT in heparinized clients?

1500-2000 mL/day

What is normal adult urinary output?

Protamine Sulfate

What is the antidote to Heparin?

It decreases the heart's need for oxygen & makes the heart not have to work as hard.

What is the best nursing response to make when a client who is experiencing an acute MI asks why the nurse is administering intravenous morphine?

Pulmonary Edema

_______________ can develop during the oliguric phase of Acute Renal Failure because of decreased urine output and fluid retention.

Dobutamine

________________ increases CO for clients with acute heart failure and those undergoing cardiopulmonary bypass surgery.

Atherosclerosis (plaque formation)

________________ is the leading cause of CAD.